Tonsillitis is a common condition where the tonsils at the back of the throat become swollen and painful. What complications can arise from tonsillitis and how can it be diagnosed and treated?

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Tonsillitis is inflammation of the tonsils, two fleshy masses of tissue at the back of the throat. The tonsils are part of the immune system, and work by helping to prevent germs from entering the body through the mouth and nose.

Tonsillitis is most common between the ages of five and ten, and 15 and 25 years, but can affect people of any age.

Most cases of tonsillitis are caused by a viral infection, but less commonly can be due to a bacterial infection.

Tonsillitis symptoms

Symptoms of tonsillitis can vary from person to person, but may include:

• A sore throat

• Difficulty swallowing

• Pain when swallowing

• Fever (a temperature above 38°C)

• Headache

• Earache

• Cough

• Red, swollen tonsils

• Nausea (feeling sick)

• Loss of appetite

• Snoring

• Fatigue

• Bad breath

• Swollen, painful lymph nodes (the glands on either side of your neck)

• Pus-filled spots or white or yellow patches on your tonsils

What causes tonsillitis?

Tonsillitis is usually caused by a virus, such as a cold, but it can also be due to a bacterial infection such as strep throat.

Complications of tonsillitis

Complications due to tonsillitis are very rare. Bacterial tonsillitis is more likely to lead to complications than viral tonsillitis.

Possible complications of tonsillitis include:

• Quinsy (peritonsillar abscess) 

• Otitis media (middle ear infection) 

• Obstructive sleep apnoea (OSA)

• Rheumatic fever 

• Scarlet fever 

• Glomerulonephritis 

When to see a doctor about tonsillitis

Viral tonsillitis normally gets better without treatment after around three to four days. Bacterial tonsillitis may need to be treated with antibiotics.

See your GP if:

• Your symptoms last for more than four days

• Your tonsillitis keeps coming back

How is tonsillitis diagnosed?

Your GP will normally diagnose tonsillitis by asking you about your symptoms and examining the back of your throat.

If your GP suspects you have bacterial tonsillitis, they may take a swab of the back of your throat to send to the laboratory for analysis.

If your tonsillitis is severe and lasts longer than usual, your GP may order a blood test to check for glandular fever (infectious mononucleosis).

Glandular fever is a viral infection most common among teenagers and young adults. It causes flu-like symptoms including a sore throat, swollen glands and fatigue. It is spread by close contact such as kissing and sharing items like cups and toothbrushes.

Tonsillitis treatment

So, how do you treat tonsillitis?

Well, tonsillitis usually gets better on its own within a few days. To help relieve your symptoms, you can try some home remedies for tonsillitis including:

• Lots of rest

• Plenty of fluids, especially cool drinks, to help soothe your throat

• Over-the-counter medicines such as paracetamol, ibuprofen, lozenges, or throat sprays (your pharmacist can advise you on suitable medications)

• Gargling with warm salty water (this is not safe for children)

If your tonsillitis symptoms don’t improve within four days, make an appointment to see your GP.

Antibiotics

If you have bacterial tonsillitis, your GP may prescribe antibiotics. Unfortunately, antibiotics don’t work for viral infections.

Surgery

Surgery to remove the tonsils is called a tonsillectomy and was routinely performed in the past to treat tonsillitis.

Nowadays, tonsillectomies are rare as the tonsils play an important role in a child’s developing immune system and help to prevent infections. By the time we reach adulthood, our tonsils have normally disappeared completely, though this doesn’t happen in some people.

If you, or your child, keep getting tonsillitis, your doctor may recommend a tonsillectomy.

Tonsillitis FAQs

Is tonsillitis contagious?

Tonsillitis itself is not contagious. However, the infections that cause it usually are, such as colds, flu, glandular fever, and streptococcus.

If you have tonsillitis, you should avoid contact with other people as much as possible until you feel better. You can also help to prevent the spread of infection by using tissues when coughing and sneezing (and throwing them away), not sharing utensils such as cups and cutlery, and washing your hands frequently, especially after coughing or sneezing.

What does tonsillitis look like?

Tonsillitis makes your tonsils appear red and swollen. In some cases, your tonsils may have a white or yellow coating or be covered with patches or pus-filled spots.

What’s the difference between viral and bacterial tonsillitis?

The difference between viral and bacterial tonsillitis is the cause. Viral tonsillitis is caused by viruses such as cold or flu viruses, adenoviruses, the Epstein-Barr virus, herpes simplex virus, measles, or cytomegalovirus. Bacterial tonsillitis is caused by bacteria, like streptococcus.

Bacterial tonsillitis is usually more serious than viral tonsillitis and may need treatment with antibiotics.

How long does tonsillitis last?

In most cases, symptoms of tonsillitis will go away after three to four days.

What’s the difference between strep throat and tonsillitis?

Strep throat is a bacterial infection caused by the bacteria streptococcus. Tonsillitis is inflammation (redness, pain, and swelling) of the tonsils. Strep throat may cause tonsillitis.

Can you get tonsillitis without tonsils?

You can’t get tonsillitis without tonsils, but you can have a sore throat due to other conditions like laryngitis, glandular fever, or strep throat.

When is tonsillitis an emergency?

In rare cases, tonsillitis can be severe, or may lead to complications which may be serious.

Seek immediate medical attention if you or your child:

• Have symptoms that have not improved for more than 4 days

• Have a severe sore throat that gets worse quickly

• Have difficulty breathing

• Have difficulty eating and drinking

• Have difficulty opening your mouth

• Have one tonsil larger than the other

• Are drooling

• Have muffled speech

• Have pus-filled (white or yellow) spots on your tonsils

• Have swelling inside your mouth and throat

• Have symptoms of strep throat

Babies and young children may not be able to tell you how they feel. Seek immediate medical attention if your baby or young child:

• Refuses to feed or isn’t eating

• Cries or fusses more than usual

• Produces more saliva than usual

• Appears to have difficulty breathing